Using an oximeter probe to detect intestinal ischemia

ABSTRACT

Devices and systems have a sensor probe configured to measure tissue oxygen saturation in the intestine or mesentery. The devices and systems can determine the oxygenation state of the entire thickness of the intestine or mesentery. Embodiments of the invention also include methods for inducing a temporary ischemic period in an intestine or mesentery tissue and analyzing changes in oxygen saturation of the tissue during the temporary ischemic period or during a recovery phase. The devices, systems, and methods can be applied in diagnosing intestinal ischemia in a patient, as well as in monitoring tissue oxygen saturation of the intestine or mesentery during or after a surgical procedure.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application is a continuation of U.S. patent applicationSer. No. 15/683,730, filed Aug. 22, 2017, issued as U.S. Pat. No.10,368,749 on Aug. 6, 2019, which is a divisional of U.S. patentapplication Ser. No. 12/410,155, filed Mar. 24, 2009, issued as U.S.Pat. No. 9,737,213 on Aug. 22, 2017. These applications are incorporatedby reference along with all other references cited in this application.

BACKGROUND OF THE INVENTION

The invention relates to the field of medical devices, their use andmanufacture, and more specifically to medical devices and techniques fordiagnosing intestinal ischemia or bowel ischemia.

Intestinal ischemia or bowel ischemia is a term used to describe theresult of a variety of disorders that cause insufficient blood flow tothe gastrointestinal tract. Ischemia can be localized to a relativelysmall part of the small intestine or large intestine, or it may bewidespread and involve both types of intestines. Moreover, ischemicnecrosis (i.e., localized death of living cells) of the intestine can besuperficial, involving mucosa (inner lining) to full thicknesstransmural necrosis. Intestinal ischemia can manifest with symptomsranging from a mild, short-lived abdominal pain, to bloody diarrhea or amore serious situation that may require surgery.

There are several causes for intestinal ischemia. The most common causeis diminished intestine perfusion resulting from low cardiac output. Itis often seen in patients with cardiac disease or in patients withprolonged shock of any etiology. Another cause of intestinal ischemia isan occlusive disease of the vascular supply to the intestine. Theocclusive disease can result from atheroma (i.e., a deposit oflipid-containing plaques an inner wall layer of an artery), thrombosis(i.e., a stationary clot attached to the blood vessel wall), or embolism(i.e., a migrating blood clot that forms a blockage) in which thecollateral circulation is not adequate to maintain intestine integrity.Another common form of intestinal ischemia is ischemic colitis, in whichinflammation and injury of the colon result from inadequate bloodsupply.

When ischemic bowel disease severely damages tissue in the intestine,the damaged tissue must be surgically removed. The remaining tissue canbe sewn together, typically in end-to-end anastomosis (i.e., surgicalconnection of two severed tubular organ parts). Prior to resection, asurgeon must distinguish between viable and nonviable intestinal tissue.Typically, the surgeon relies on subjective visual inspection such astissue color to determine which intestinal tissue is viable. Such adecision is often made hastily during operation. Further, such visualinspection has been shown to be unreliable in determining long-termviability of intestinal tissue.

Determining intestine viability is difficult but important for patientswith ischemic bowel disease. If nonviable tissue is not removed, theresult can be fatal. Removing too much intestine can also lead to severecomplications. Thus, there is a need for better medical devices andsystems that can determine the oxygenation state of the entire thicknessof an intestinal tissue as well as other tissues. Improved devices andsystem can better assist doctors in determining viability of anintestinal tissue, and the doctors can make a better informed decisionregarding a treatment plan for the patient. The present invention meetsthis and other needs.

BRIEF SUMMARY OF THE INVENTION

In one aspect of the invention, a needle sensor device includes a hollowneedle and a sensor probe disposed inside the hollow needle. A bevelededge of the hollow needle can be used to puncture a tissue, such as anouter tissue of an abdomen, to introduce the needle sensor device insidethe abdomen to measure oxygen saturation of a serosal surface of theintestine or mesentery.

The sensor probe has one or more optical fibers where distal ends of theoptical fibers form an oximeter sensor at its tip, which allowsmeasuring of oxygen saturation of a tissue. In one embodiment, the oneor more optical fibers include a first optical fiber and a secondoptical fiber, which are separated by a given distance so that thesensor probe is configured to measure oxygen saturation value from afull thickness of an intestinal wall tissue. For example, distal ends ofthe first and second optical fibers are separated by a distance of about2 millimeters or less.

In another aspect of the invention, a system includes a needle sensordevice and a system unit (e.g., a console) including a display,processor, signal emitter circuit, signal detector circuit, and areceptacle to couple to proximal ends of the one or more optical fibers.The signal emitter circuit sends a signal through the one or moreoptical fibers, and the signal detector circuit receives the signal fromthe one or more optical fibers. The receptacle may be removably coupledto proximal ends of the one or more optical fibers.

The signal emitter circuit may include at least one of a laser emitteror light emitting diode (LED) emitter. The signal emitter circuit mayfurther cause an optical signal, having a wavelength from about 600nanometers to about 900 nanometers, to be transmitted through the one ormore optical fibers through sensor openings at the tip of the sensorprobe. Furthermore, the signal emitter circuit may cause an opticalsignal having a two or more different wavelengths to be transmittedthrough the sensor openings.

A first wavelength of the two or more different wavelengths may be about690 nanometers. A second wavelength of the two or more differentwavelengths may be about 830 nanometers.

In an embodiment to measure oxygen saturation of tissue touching the tipof device, the system unit determines a first quantity corresponding toan intensity of light of a first wavelength transmitted from a firstsensor opening of the tip through the tissue to a second sensor openingof the tip. The system unit also determines a second quantitycorresponding to an intensity of light of a second wavelengthtransmitted from the first sensor opening of the tip through the tissueto the second sensor opening of the tip, where the second wavelength isdifferent from the first wavelength. Then the system unit calculates anattenuation ratio of the first quantity to the second quantity.

In yet another aspect of the invention, a method includes puncturing anouter tissue with a needle sensor device. The needle sensor devicecontacts an intestinal or mesentery tissue with the tip of the sensorprobe, transmitting a first light, having a wavelength between about 600nanometers to about 900 nanometers, into the tissue through the tip ofthe sensor probe, and receiving a second light reflected from the tissuethrough the tip of the sensor probe. Then an oxygen saturation value forthe tissue is determined based on values for the first and second light.

In yet another aspect of the invention, a method includes puncturing anouter tissue with a trocar. The needle sensor device is introduced intoan abdominal cavity through the trocar. The method includes contactingan intestinal or mesentery tissue with the tip of the sensor probe,transmitting a first light, having a wavelength between about 600nanometers to about 900 nanometers into the tissue through the tip ofthe sensor probe, and receiving a second light reflected from the tissuethrough the tip of the sensor probe. Then an oxygen saturation value forthe tissue is determined based on values for the first and second light.

In yet another aspect of the invention, a method includes inducing atemporary ischemic period for an intestinal or mesentery tissue of apatient by constricting a mesenteric artery that supplies blood to thetissue. The method includes measuring oxygen saturation of the tissueduring the temporary ischemic period and analyzing the oxygen saturationof the tissue during the temporary ischemic period. The patient can bediagnosed as having intestinal ischemia according to changes in theoxygen saturation in the tissue during the temporary ischemic period.

In yet another aspect of the invention, a system includes a device forinducing a temporary ischemic period in an intestinal or mesenterytissue, a sensor probe that measures oxygen saturation of the tissueduring the temporary ischemic period, and a system unit coupled to thesensor probe, that analyzes oxygen saturation in the tissue during thetemporary ischemic period and diagnoses the patient as having intestinalischemia according to the oxygen saturation in the tissue during thetemporary ischemic period.

In yet another aspect of the invention, a method includes inducing atemporary ischemic period for an intestinal or mesentery tissue of apatient by constricting a mesenteric artery that supplies blood to thetissue, measuring oxygen saturation of the tissue during a recovery fromthe temporary ischemic period, after removing a constriction to themesenteric artery, analyzing the oxygen saturation of the tissue duringrecovery, and diagnosing the patient as having intestinal ischemiaaccording to changes in the oxygen saturation in the tissue during therecovery.

In yet another aspect of the invention, a system includes a device forinducing a temporary ischemic period in an intestinal or mesenterytissue, a sensor probe that measures oxygen saturation of the tissueduring recovery from the temporary ischemic period, and a system unit,coupled to the sensor probe, that analyzes oxygen saturation in thetissue during the recovery and diagnoses the patient as havingintestinal ischemia according to the oxygen saturation in the tissueduring the recovery.

Other objects, features, and advantages of the present invention willbecome apparent upon consideration of the following detailed descriptionand the accompanying drawings, in which like reference designationsrepresent like features throughout the figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a block diagram of an oximeter system for measuring oxygensaturation of tissue in a patient.

FIG. 2 shows a more detailed block diagram of a specific implementationof the system of FIG. 1.

FIG. 3A shows a system of the invention including a monitoring console,a catheter device, and a cable connecting the catheter device to themonitoring console.

FIG. 3B shows a distal end surface of the catheter device shown in FIG.3A, where distal ends of two optical fibers form an oximeter sensor.

FIG. 4A shows a distal end surface of a catheter device having foursensor openings in a linear array.

FIG. 4B shows a distal end surface of a catheter device having foursensor openings forming a square.

FIG. 4C shows a distal end surface of a catheter device having foursensor openings forming a quadrilateral, where a line drawn between afirst sensor opening and a second sensor opening is not parallel to aline drawn between a third sensor opening and a fourth sensor opening.

FIG. 5 shows a distal end surface of a catheter device having fivesensor openings, where each sensor opening includes a fiber opticbundle.

FIG. 6A shows a distal end surface of a catheter device with a singlesensor opening having an optical fiber with multiple light channels.

FIG. 6B shows a distal end surface of another catheter device with asingle sensor opening with an optical fiber with multiple lightchannels.

FIG. 7A shows a catheter device that has a single sensor opening at thetip and a single optical fiber bundle connected to the sensor opening ata distal end.

FIG. 7B shows a catheter device that has a single sensor opening at thetip and a distal end of a single optical fiber connected to the sensoropening, and a proximal end of the single optical fiber combined withtwo optical fibers by a fiber combiner.

FIG. 8A shows a catheter device with distal ends of optical fiberslocated at a peripheral surface at the tip of the catheter device.

FIG. 8B shows a catheter device with an inflatable balloon expanding thetip of the catheter device.

FIG. 9A shows an endoscopic device with a sensor probe inserted into aninstrument channel of the endoscopic device.

FIG. 9B shows a tip of an elongated shaft of the endoscopic device wherea sensor probe can be extended beyond a distal end surface of theelongated shaft.

FIG. 10A shows a catheter device that includes a marking mechanism.

FIG. 10B shows an endoscopic device that includes a marking mechanism.

FIG. 11A shows a system that includes a needle sensor device that has ahollow needle with a beveled edge and a sensor probe disposed inside thehollow needle.

FIG. 11B shows a distal end of the hollow needle shown in FIG. 11A wherethe tip of the sensor probe is disposed inside the hollow needle.

FIG. 11C shows a distal end of the hollow needle shown in FIG. 11A wherethe tip of the sensor probe is extended beyond a distal end of thehollow needle.

FIG. 11D shows the use of a trocar in combination with a needle sensordevice to introduce a sensor probe into an abdominal cavity.

FIG. 12 shows a flow diagram for operating a catheter device, endoscopicdevice, or needle sensor device in measuring oxygen saturation of theintestine or mesentery.

FIG. 13 shows a flow diagram of operating a catheter device, endoscopicdevice, or needle sensor device and marking a tissue of the intestine ormesentery with a marking mechanism.

FIG. 14A shows a large intestine and mesenteric arteries labeled Athrough E which supply blood to the large intestine, where themesenteric arteries are clipped to stop or reduce the blood flow to thelarge intestine to induce a temporary ischemia.

FIG. 14B shows changes in oxygen saturation level of a healthy largeintestine tissue.

FIG. 14C shows changes in oxygen saturation level of a large intestinetissue which suffers from intestinal ischemia where a temporary inducedischemia does not affect the oxygen saturation of the tissue.

FIG. 14D shows a resection of an intestinal tissue which suffers from anintestinal ischemia.

FIG. 14E shows an anastomosis procedure where a healthy portion of thelarge intestine is joined with the anus region.

FIG. 15 shows a flow diagram for analyzing oxygen saturation changes ofan intestinal or mesentery tissue during an induced ischemic period todetermine if a patient is suffering from intestinal ischemia.

FIG. 16A shows a graph that shows oxygen saturation changes of a healthyintestinal or mesentery tissue during an induced ischemic period andduring recovery.

FIG. 16B shows a graph that shows oxygen saturation changes of anintestinal or mesentery tissue that is already ischemic during aninduced ischemic period and during recovery.

FIG. 17 shows a flow diagram for analyzing oxygen saturation changes ofan intestinal or mesentery tissue during recovery phase from an inducedischemia to determine if a patient is suffering from intestinalischemia.

DETAILED DESCRIPTION OF THE INVENTION

When blood supply to a tissue or organ within a body is diminished dueto a poor circulation or blockage of blood vessels, the tissue or organsuffers ischemia which results in diminished functioning of the tissueor organ. The tissue or organ ischemia can present various symptoms in apatient which makes a proper diagnosis of the underlying diseasedifficult for a doctor. Consequently, an ischemic disease is often notdiagnosed until an advanced stage, which limits treatment options forthe patient.

This is particularly the case for a patient suffering with intestinalischemia. The ischemic condition or oxygenation state of an internalorgan, such as the intestine or mesentery, is difficult to evaluate. Theintestine is a long tubular organ which can stretch about 7 feet long.The mesentery is a fold of tissue which anchors the intestine to theback of the abdominal wall. Blood vessels, nerves, and lymphatics branchthrough the mesentery to supply the intestine. Since the intestine andmesentery involve an extensive network of tissues, it is difficult tolocalize an ischemic area in the tissue.

The present invention provides various medical devices and systems formeasuring oxygen saturation of a tissue located inside a body. Inparticular, the devices and systems can be used to measure oxygensaturation of mouth, esophagus, stomach, small intestine, largeintestine, mesentery, anus, or others. While some of these body partsmay be classified as organs, for this application, “tissue” and “organ”are used interchangeably to refer to any body part or aggregate ofcells. In other words, “tissue” may be used to refer to an organ, andvice versa.

The medical devices and systems in accordance with embodiments of theinvention include a catheter device, an endoscopic device, and a needlesensor device which allow the doctor to explore tissues deep inside abody noninvasively or with a minimal pin size puncture. In embodimentsof the invention, the devices include a sensor probe that has one ormore optical fibers that form an oximeter at a distal end of the sensorprobe. As the devices are guided down along the gastrointestinal tract,the oximeter sensor of the sensor probe can contact a tissue and measureoxygen saturation at various locations along the tract.

In embodiments of the invention, the sensor probe is connected to asignal emitter which sends light having a wavelength between about 600nanometers to about 900 nanometers through optical fibers in the sensorprobe into a tissue. After being scattering and absorbed by chromophores(e.g., hemoglobin) in the tissue, an attenuated version of the light isdetected by the sensor probe and is transmitted to a photodetector.Based on values of the initial light and the attenuated version of thelight, an oxygen saturation value of the tissue can be obtained. Basedon the oxygen saturation value of the tissue, it can be determinedwhether the tissue is suffering from ischemia.

Embodiments of the invention can be used in a wide variety ofapplications. One application is in diagnosing whether or not a patienthas intestinal ischemia. Moreover, the devices and systems can be usedto determine the severity of intestinal ischemia and the extent oftissue damage. In another application, the devices and systems can beused in monitoring oxygen saturation of an intestinal tissue ormesentery during a surgical procedure (e.g., anastomosis). Since oxygensaturation measurements can be made in real-time during surgery, anynecessary modifications to surgical procedures can be made based onoxygen saturation measurements. Furthermore, the devices and systems canalso be used during recovery after surgery to evaluate a patient'sprognosis.

Embodiments of the present invention provide several advantages. Thecatheter and endoscopic devices can be inserted into a human bodynoninvasively to determine the oxygenation state of a mucosal surface ofthe intestine or any other tissue along the gastrointestinal tract.Moreover, the sensor needle device can be introduced into an abdomenwith a pin size hole to determine the oxygenation state of a serosalsurface of the intestine or mesentery. These devices cause minimaldiscomfort to the patient and rarely cause any medical complications.

Moreover, the devices and systems according to embodiments of theinvention provide oxygen saturation measurements of the entire thicknessof the intestine, not just an outer skin or superficial surface of theintestine. An oximeter sensor of the present devices and systems alsodirectly contact a tissue to make oxygen saturation measurements of thetissue. Thus, the oxygen saturation measurements according toembodiments of the invention can assess the oxygenation state of theintestine more accurately.

Further, sensor probes, catheter devices, and sensor needle devices ofthe present invention are cost effective to manufacture since theyinclude mostly optical fibers and do not contain parts such as lightemitting diodes or photodiodes, which are relatively expensive. The costeffectiveness is important as the devices containing a sensor probe aretypically disposed after a single use. Also, since the portion of adevice that is introduced into a body cavity does not include electricalcomponents such as light emitting diodes, photodiodes, or electricalwires, there is no risk that internal organs will get an electricalshock, heated, or burned by the device.

Examples of embodiments of the invention are illustrated using figuresand are described below. The figures described herein are used toillustrate embodiments of the invention, and are not in any way intendedto be restrictive of the broad invention. Embodiments of the inventionare not limited to the specific arrangements and constructions shown anddescribed. For example, features shown in one figure can be combinedwith features shown in another figure.

FIG. 1 shows an oximeter system 101 for measuring oxygen saturation of atissue in a patient. The system includes a system unit 105 and a sensorprobe 108, which is connected to the system unit via a wired connection112. Connection 112 may be an electrical, optical, or another wiredconnection including any number of wires (e.g., one, two, three, four,five, six, or more wires or optical fibers), or any combination of theseor other types of connections. In other implementations of theinvention, however, connection 112 may be wireless such as via a radiofrequency (RF) or infrared communication.

Typically, the system is used by placing the sensor probe in contact orclose proximity to tissue (e.g., intestine or mesentery) at a site whereoxygen saturation or other related measurement is desired. The systemunit causes an input signal to be emitted by the sensor probe into thetissue (e.g., human tissue). There may be multiple input signals, andthese signals may have varying or different wavelengths. The inputsignal is transmitted into or through the tissue.

Then, after transmission through or reflection off the tissue, thesignal is received at the sensor probe. This received signal is receivedand analyzed by the system unit. Based on the received signal, thesystem unit determines the oxygen saturation of the tissue and displaysa value on a display of the system unit.

In an implementation, the system is a tissue oximeter, which can measureoxygen saturation without requiring a pulse or heart beat. A tissueoximeter of the invention is applicable to many areas of medicine andsurgery including plastic surgery and spinal surgery. The tissueoximeter can make oxygen saturation measurements of tissue where thereis no pulse; such tissue, for example, may have been separated from thebody (e.g., a flap) and will be transplanted to another place in thebody.

Aspects of the invention are also applicable to a pulse oximeter. Incontrast to a tissue oximeter, a pulse oximeter requires a pulse inorder to function. A pulse oximeter typically measures the absorbance oflight due to the pulsing arterial blood.

There are various implementations of systems and techniques formeasuring oxygen saturation such as discussed in U.S. Pat. Nos.6,516,209, 6,587,703, 6,597,931, 6,735,458, 6,801,648, 7,247,142, and7,355,688. These patents are assigned to the same assignee as thispatent application and are incorporated by reference along with allother references cited in this application.

Various equations for self-calibration schemes are also known in theart. Self-calibration schemes are used to adjust for system factors suchas source intensity, detector gain, and loss of light in the opticalfibers and connectors. The self-calibration scheme may include equationsdiscussed in U.S. Pat. Nos. 6,516,209, 6,735,458, and 6,078,833, and NewOptical Probe Designs for Absolute (Self-Calibrating) NIR TissueHemoglobin Measurements, Proc. SPIE 3597, pages 618-631 (1999), whichare incorporated by reference.

The attenuation ratio method may also include techniques discussed inU.S. Pat. No. 6,587,701, which is incorporated by reference. Theattenuation ratio method is used to determine tissue oxygenation,hemoglobin concentration, or both. Additional detail on self-calibrationschemes and attenuation ratio methods is also discussed in U.S. patentapplication Ser. No. 12/126,860, filed May 24, 2008, which isincorporated by reference.

FIG. 2 shows greater detail of a specific implementation of the systemof FIG. 1. The system includes a processor 204, display 207, speaker209, signal emitter 231, signal detector 233, volatile memory 212,nonvolatile memory 215, human interface device or HID 219, I/O interface222, and network interface 226. These components are housed within asystem unit enclosure. Different implementations of the system mayinclude any number of the components described, in any combination orconfiguration, and may also include other components not shown.

The components are linked together using a bus 203, which represents thesystem bus architecture of the system. Although this figure shows onebus that connects to each component, the busing is illustrative of anyinterconnection scheme serving to link the subsystems. For example,speaker 209 could be connected to the other subsystems through a port orhave an internal direct connection to processor 204.

A sensor probe 246 of the system includes a probe 238 and connector 236.The probe is connected to the connector using wires 242 and 244. Theconnector removably connects the probe and its wires to the signalemitter and signal detectors in the system unit. There is one cable orset of cables 242 to connect to the signal emitter, and one cable or setof cables 244 to connect to the signal detector. In an implementationthe cables are fiber optic cables, but in other implementations, thecables are electrical wires.

Signal emitter 231 is a light source that emits light at one or morespecific wavelengths. In a specific implementation, two wavelengths oflight (e.g., 690 nanometers and 830 nanometers) are used. In otherimplementations, other wavelengths of light may be used. The signalemitter is typically implemented using a laser diode or light emittingdiode (LED). Signal detector 233 is typically a photodetector capable ofdetecting the light at the wavelengths produced by the signal emitter.

The connector may have a locking feature; e.g., insert connector, andthen twist or screw to lock. If so, the connector is more securely heldto the system unit and it will need to be unlocked before it can beremoved. This will help prevent accidental removal of the probe.

The connector may also have a first keying feature, so that theconnector can only be inserted into a connector receptacle of the systemunit in one or more specific orientations. This will ensure that properconnections are made.

The connector may also have a second keying feature that provides anindication to the system unit which type of probe is attached. Thesystem unit may handle making measurements for a number of differenttypes of probes. When a probe is inserted, the system uses the secondkeying feature to determine which type of probe is connected to thesystem. Then the system can perform the appropriate functions, use theproper algorithms, or otherwise make adjustments in its operation forthe specific probe type.

For example, when the system detects a cerebral probe is connected, thesystem uses cerebral probe algorithms and operation. When the systemdetects a thenar probe is connected, the system uses thenar probealgorithms and operation. A system can handle any number of differenttypes of probes. There may be different probes for measuring differentparts of the body, or different sizes or versions of a probe formeasuring a part of the body (e.g., three different thenar probemodels).

With the second keying feature, the system will be able to distinguishbetween the different probes. The second keying feature can use any typeof coding system to represent each probe including binary coding. Forexample, for a probe, there are four second keying inputs, each of whichcan be a logic 0 or 1. With four second keying inputs, the system willbe able to distinguish between sixteen different probes.

Probe 246 may be a handheld tool and a user moves the probe from onepoint to another to make measurements. However, in some applications,probe 246 is part of an endoscopic instrument or robotic instrument, orboth. For example, the probe is moved or operated using a guidinginterface, which may or may not include haptic technology.

In various implementations, the system is powered using a wall outlet orbattery powered, or both. Block 251 shows a power block of the systemhaving both AC and battery power options. In an implementation, thesystem includes an AC-DC converter 253. The converter takes AC powerfrom a wall socket, converts AC power to DC power, and the DC output isconnected to the components of the system needing power (indicated by anarrow 254). In an implementation, the system is battery operated. The DCoutput of a battery 256 is connected to the components of the systemneeding power (indicated by an arrow 257). The battery is rechargedusing a recharger circuit 259, which received DC power from an AC-DCconverter. The AC-DC converter and recharger circuit may be combinedinto a single circuit.

The nonvolatile memory may include mass disk drives, floppy disks,magnetic disks, optical disks, magneto-optical disks, fixed disks, harddisks, CD-ROMs, recordable CDs, DVDs, recordable DVDs (e.g., DVD-R,DVD+R, DVD-RW, DVD+RW, HD-DVD, or Blu-ray Disc), flash and othernonvolatile solid-state storage (e.g., USB flash drive),battery-backed-up volatile memory, tape storage, reader, and othersimilar media, and combinations of these.

The processor may include multiple processors or a multicore processor,which may permit parallel processing of information. Further, the systemmay also be part of a distributed environment. In a distributedenvironment, individual systems are connected to a network and areavailable to lend resources to another system in the network as needed.For example, a single system unit may be used to collect results fromnumerous sensor probes at different locations.

Aspects of the invention may include software executable code orfirmware (e.g., code stored in a read only memory or ROM chip). Thesoftware executable code or firmware may embody algorithms used inmaking oxygen saturation measurements of the tissue. The softwareexecutable code or firmware may include code to implement a userinterface by which a user uses the system, displays results on thedisplay, and selects or specifies parameters that affect the operationof the system.

Further, a computer-implemented or computer-executable version (e.g.,computer program product) of the invention may be embodied using, storedon, or associated with a computer-readable medium. A computer-readablemedium may include any medium that participates in providinginstructions to one or more processors for execution. Such a medium maytake many forms including, but not limited to, nonvolatile, volatile,and transmission media. Nonvolatile media includes, for example, flashmemory, or optical or magnetic disks. Volatile media includes static ordynamic memory, such as cache memory or RAM. Transmission media includescoaxial cables, copper wire, fiber optic lines, and wires arranged in abus. Transmission media can also take the form of electromagnetic, radiofrequency, acoustic, or light waves, such as those generated duringradio wave and infrared data communications.

For example, a binary, machine-executable version, of the software ofthe present invention may be stored or reside in RAM or cache memory, oron a mass storage device. Source code of the software of the presentinvention may also be stored or reside on a mass storage device (e.g.,hard disk, magnetic disk, tape, or CD-ROM). As a further example, codeof the invention may be transmitted via wires, radio waves, or through anetwork such as the Internet. Firmware may be stored in a ROM of thesystem.

Computer software products may be written in any of various suitableprogramming languages, such as C, C++, C#, Pascal, Fortran, Perl, Matlab(from MathWorks, www.mathworks.com), SAS, SPSS, JavaScript, AJAX, andJava. The computer software product may be an independent applicationwith data input and data display modules. Alternatively, the computersoftware products may be classes that may be instantiated as distributedobjects. The computer software products may also be component softwaresuch as Java Beans (from Sun Microsystems) or Enterprise Java Beans (EJBfrom Sun Microsystems).

An operating system for the system may be one of the Microsoft Windows®family of operating systems (e.g., Windows 95, 98, Me, Windows NT,Windows 2000, Windows XP, Windows XP x64 Edition, Windows Vista, WindowsCE, Windows Mobile), Linux, HP-UX, UNIX, Sun OS, Solaris, Mac OS X,Alpha OS, AIX, IRIX32, or IRIX64. Microsoft Windows is a trademark ofMicrosoft Corporation. Other operating systems may be used, includingcustom and proprietary operating systems.

Furthermore, the system may be connected to a network and may interfaceto other systems using this network. The network may be an intranet,internet, or the Internet, among others. The network may be a wirednetwork (e.g., using copper), telephone network, packet network, anoptical network (e.g., using optical fiber), or a wireless network, orany combination of these. For example, data and other information may bepassed between the computer and components (or steps) of a system of theinvention using a wireless network using a protocol such as Wi-Fi (IEEEstandards 802.11, 802.11a, 802.11b, 802.11e, 802.11g, 802.11i, and802.11n, just to name a few examples). For example, signals from asystem may be transferred, at least in part, wirelessly to components orother systems or computers.

In an embodiment, through a Web browser or other interface executing ona computer workstation system or other device (e.g., laptop computer,smartphone, or personal digital assistant), a user accesses a system ofthe invention through a network such as the Internet. The user will beable to see the data being gathered by the machine. Access may bethrough the World Wide Web (WWW). The Web browser is used to downloadWeb pages or other content in various formats including HTML, XML, text,PDF, and postscript, and may be used to upload information to otherparts of the system. The Web browser may use uniform resourceidentifiers (URLs) to identify resources on the Web and hypertexttransfer protocol (HTTP) in transferring files on the Web.

FIG. 3A shows a schematic diagram of a specific implementation of asystem. Shown in FIG. 3A is a system 300 that includes a catheter device303 which contains a sensor probe 333 with an oximeter sensor at itsdistal end. The catheter device has a shaft portion 305 and a connector311. The catheter device is connected to a console 306 via a cable 309.Connector 311 at a proximal end of the catheter device is connected to aconnector 313 of cable 309. The cable is connected to a receptacle 315which is located at the console.

Shaft portion 305 of the catheter device is typically flexible, and canbe of any suitable length. For example, the shaft of the catheter devicecan have a length of about 5 centimeters to about 10 meters, or anylength between these lengths. The selection of a shaft length depends onthe end use of the catheter device. For example, when the catheterdevice is used to examine an esophagus area of a patient, a relativelyshort catheter device (e.g., 20 centimeters in length) can be used. Whenexamining a small intestine area of a patient, a relatively longcatheter device (e.g., 7 meters in length) is used since the catheterdevice travels a long distance to the small intestine from the insertionpoint (e.g., mouth or anus).

In one implementation of the invention, the catheter device may havemarkings on an outer surface of the shaft. For example, the outersurface of the shaft may have markings at intervals of every 10millimeters starting at a distal end of the shaft (e.g., 10, 20, 30millimeters, and so forth). The markings on the outer surface of theshaft can assist a doctor to determine a length of the shaft that isinserted into a body cavity and where the distal end of the catheterdevice is located during an exploratory procedure.

A diameter of the catheter device can be of any suitable dimensiondepending on its end application. For example, the diameter of thecatheter device can vary between about 1 to 20 millimeters, moretypically between about 1.5 to 10 millimeters, even more typicallybetween about 2 to 5 millimeters. When the catheter device is insertedinto the mouth of a patient, it is desirable to minimize the diameter ofthe catheter device for the patient's comfort. However, it may bedesirable to use a catheter device with a larger diameter, since alarger catheter device can hold optical fibers having a larger diameter,which may result in stronger optical signals.

FIG. 3B illustrates a perspective view of a distal end of one embodimentof a catheter device 330. The catheter device contains sensor probe 333having a first optical fiber 323 and a second optical fiber 325 along alongitudinal axis of the shaft of the catheter device. Sensor probe 333is surrounded by an outer sheath 321 which provides a structuralintegrity and protection for the sensor probe. Typically, distal ends ofthe optical fibers are exposed at the tip of the catheter device. Theproximal ends of the optical fibers (not shown in FIG. 3B) are connectedto a console through a cable.

As shown in FIG. 3B, distal ends of optical fibers 323 and 325 are heldin place by a filler material 327. The filler material separates andfixes distal ends of the optical fibers by a suitable distance tooptimize optical signaling for a given tissue. The filler material mayextend the entire length of the shaft; alternatively, the fillermaterial may be applied only at the distal end of the catheter device tofirmly fix the distal ends of the optical fibers.

Any suitable filler material can be used as long as it is chemically andstructurally stable, and does not interfere with transmission of opticalsignals in the optical fibers. For example, the filler material can beepoxy. The epoxy material can be cured around the distal ends of theoptical fibers. Alternatively, the entire length of the shaft of thecatheter device can be filled with an epoxy or other material, and thena suitable number of channels can be burrowed in the filler material tothread the optical fibers through.

Outer sheaths of catheter devices are formed of a flexible, durablematerial such as a medical grade polytetrafluoroethylene (PTFE). ThePTFE tubing can be easily advanced around curves of body cavities and issubstantially impervious to body fluids. Sensor probes in embodiments ofthe invention can be incorporated in commercially available catheterouter sheaths having any suitable diameters.

In one implementation, first optical fiber 323 is connected to a signalemitter circuit via a cable interface, and second optical fiber 325 isconnected to a signal detector circuit via a cable interface. Lightgenerated by the signal emitter (e.g., a radiation source such as laserdiode, photodiodes) travels down the first optical fiber and istransmitted into a tissue. After the light enters the tissue, lightscatters due to the heterogeneous structure of the tissue, and some ofthe light is absorbed by chromophores such as hemoglobin. An attenuatedversion of the light that is reflected from the tissue is detected bythe second optical fiber and is transmitted to the signal detector(e.g., a photodetector).

Generally, the tip of a sensor probe contacts a tissue to measureoptical characteristics of a tissue, such as tissue oxygen saturation.For example, oxygen saturation of the tissue can be calculated based ona value of the initial light generated by the signal emitter and a valueof an attenuated version of the light that is reflected from the tissue.

The tip of a sensor probe with distal ends of the optical fibers isreferred to as “an oximeter sensor.” A cross section area of an opticalfiber at the distal end of the sensor probe is referred to as “a sourcestructure” when it is configured to transmit light into a tissue. Across section area of an optical fiber at the distal end of the sensorprobe is referred to as “a detector structure” when it is configured toreceive reflected light from the tissue. The source structure anddetector structure may be collectively referred to as “openings” or“sensor openings” as they allow passage of light traveling from opticalfibers to a tissue (and reflected light from the tissue back to theoptical fibers). Further, a distance between the openings (e.g., betweena source structure and a detector structure) is typically calculatedfrom a center of one opening to a center of another opening.

The optical fibers in the sensor probe can have any suitable diameters.For example, a diameter of an optical fiber can be between about 0.1millimeters to about 2 millimeters, typically between about 0.5millimeters to about 1.5 millimeters, even more typically between about0.5 millimeters to about 1 millimeter, or any other diameter betweenthese dimensions. The selection of the optical fiber diameter may dependon many factors. For example, if it is desired to build a catheterdevice with a narrow shaft, then it is desirable to use optical fiberswith a smaller diameter. Typically, loss of signal transmission isgreater with optical fibers with a smaller diameter. Thus, a desire toproduce a catheter device with a smaller diameter needs to be balancedagainst optimizing signal transmission through the optical fibers.

The depth of light penetration into a tissue depends on, among otherfactors, a distance between a source structure and detector structure atthe distal end of the sensor probe. As shown in FIG. 3B, optical fiber323 and optical fiber 325 are separated by a distance of X. The depth oflight penetration increases with an increasing distance of X. Thus, formeasuring oxygen saturation of a thin layer of tissue or a shallowvolume of tissue, it may be desirable to use a sensor probe with asmaller separation between a source structure and a detector structure(e.g., X being equal to 1 millimeter or less). For measuring oxygensaturation of a thick layer of tissue, it may be desirable to use asensor probe with a larger separation between a source structure and adetector structure.

For measuring oxygen saturation of a thin layer of tissue, such as anintestine, the distance between a source structure and a detectorstructure at the tip of a sensor probe is relatively small. It isdesirable that the distance between the two structures is adjusted sothat light penetrates the entire wall thickness of the intestine, butnot other surrounding tissues. Typically, the intestinal wall is about 2millimeters thick. Thus, it is desirable that the distance between asource structure and a detector structure at the tip of a sensor probeis optimized to penetrate the entire thickness of the intestinal wall.For example, the distance between the two structures in the sensor probecan be between about 0.2 millimeters to about 3 millimeters, moretypically between about 0.5 millimeters to about 2 millimeters, evenmore typically between about 0.5 millimeters to about 1 millimeter, orany number between these dimensions.

Console 306 (sometimes referred to as a system unit) typically includesa display, processor, signal emitter circuit, signal detector circuit,and a receptacle to couple to proximal ends of the one or more opticalfibers. The signal emitter sends a signal through an optical fiber andthe signal detector circuit receives the signal from the same ordifferent optical fiber. The receptacle may be removably coupled toproximal ends of the first and second optical fibers.

A display screen on the console can display the patient's data, such asoxygen saturation measurements and the locations in the intestine ormesentery from which the measurements were made.

The console may also include a mass storage device to store data (e.g.,hard disks, CD-ROM drive, DVD-ROM drive, flash storage drive, orothers). The stored data may include patient information, otheridentifying information, patient medical history, oxygen saturationmeasurements and the time and data measured.

In one implementation, a discrete wavelength of light (as opposed to abroad band of light that includes many wavelengths of light, such aswhite light) is generated by a radiation source. One or more discretewavelengths of light can be generated by one or more radiation sources.

In a specific implementation, the console includes a first radiationsource and a second radiation source. The radiation sources may be dualwavelength light sources. In other words, first radiation sourceprovides two wavelengths of radiation and second radiation sourceprovides two wavelengths of radiation. First radiation source, secondradiation source, or both may include one or more laser diodes or lightemitting diodes (LEDs) that produce light in any wavelength, buttypically the wavelengths range from about 600 nanometers to about 900nanometers. In a specific implementation, a first wavelength of light isgenerated that has a wavelength of about 690 nanometers. A secondwavelength of light is generated that has a wavelength of about 830nanometers.

In a specific implementation, the signal emitter circuit may include oneor more laser emitters, light emitting diode (LED) emitters, or both.The signal emitter circuit may be used to generate an optical signalhaving two or more different wavelengths to be transmitted through thesensor unit. The wavelengths may range from about 600 nanometers toabout 900 nanometers.

In a specific implementation, one or more near-infrared radiationsources are included within the console. In other implementations, theradiation sources may be external to the console. For example, theradiation sources may be contained within a separate unit between theconsole and sensor probe. In yet another implementation, some radiationsources may be within the console while other radiation sources areexternal to the console.

These radiation sources may be near-infrared lasers. In a specificimplementation, there is one near-infrared laser located within theconsole. In other implementations, there may be more than onenear-infrared laser. For example, there may be 2, 3, 4, 5, 6, 7, 8, 9,or 10, or more than 10 radiation sources. In another implementation, theradiation sources may also include those that produce light in a visiblespectrum. In one implementation, a beam combiner can be used to mergelight from different radiation sources. The merged light can then beprovided via output fibers.

In a specific implementation, a single pulse of light is transmittedinto the tissue. In another implementation, multiple pulses of light maybe transmitted into the tissue. For example, a first pulse of light maybe received by a first detector. A second pulse of light may be receivedby a second detector.

While FIG. 3B illustrates an embodiment with two optical fibers in thesensor probe, any suitable number of optical fibers can be contained inthe sensor probe. For example, there may be one, two, three, four, five,six, seven, or eight or more optical fibers. Any one or more opticalfibers in the sensor probe can be connected to a light source totransmit light; any one or more optical fibers in the sensor probe canbe used to receive light reflected from the tissue.

FIGS. 4A through 4C illustrate examples of different arrangements ofsource structures and detector structures at a distal end of a catheterdevice.

FIG. 4A shows a distal end of a catheter device 400 where a sensor probe405 includes four openings 401-404. The sensor probe is surrounded by anouter sheath 406. As shown, the four openings are arranged in a lineararray. In one implementation, openings 401 and 402 are sensor structuresand openings 403 and 404 are detector structures. In anotherimplementation, the distance between openings 401 and 402 is equal tothe distance between openings 402 and 403; this distance is also equalto that between openings 403 and 404. While the four sensor openingsshown in FIG. 4A are equal in size, one or more sensor openings can havedifferent diameters.

While FIG. 4A shows that four sensor openings are in a linear array, inanother implementation, any three of the openings may be positioned in alinear array at the tip of the sensor probe. For example, the oximetersensor may include a first sensor emitter opening (i.e., a sourcestructure), a second sensor emitter opening, a first sensor detectoropening (i.e., a detector structure), and a second sensor detectoropening. Any three of the openings may be positioned in a lineararrangement at a distal end of the sensor probe.

In a specific embodiment, the second sensor emitter opening is betweenthe first sensor emitter opening and the first sensor detector opening,and the first sensor detector opening is between the second sensoremitter opening and the second sensor detector opening.

The first sensor detector opening may be spaced away from the secondsensor detector by about 5/3 millimeters or less, and the first sensordetector opening may be spaced away from the second sensor emitteropening by about 5/3 millimeters or less.

FIG. 4B illustrates a distal end of another catheter device 410 where asensor probe 415 includes four sensor openings 411-414. The sensor probeis surrounded by an outer sheath 416. In an implementation, thedistances between openings 411-412, 412-414, 413-414, and 413-411 areall equal. Thus, in this implementation, openings 411, 412, 413, and 414form the vertices of a square. In other implementations, however, fouropenings may form the vertices of any quadrilateral, such as arectangle, a rhombus, a trapezoid, or a parallelogram.

FIG. 4C illustrates a distal end of yet another catheter device 420which is a variation of the implementation of the sensor probe shown inFIG. 4B. Shown in FIG. 4C is a catheter device 420 where a sensor probe425 includes four sensor openings 421-424. The sensor probe issurrounded by an outer sheath 426. The four openings are positionedasymmetrically such that a line drawn through openings 421 and 422 isnot parallel to a line through openings 423 and 424.

Additionally, the distance between openings 421 and 422 is shorter thanthe distance between openings 423 and 424. Thus, in FIG. 4C, thedistance between openings 421 and 423 does not equal to the distancebetween openings 422 and 424 and the distance between openings 422 and423 does not equal to that between openings 422 and 424.

In the implementations discussed so far, each sensor opening of thesensor probe has a single optical fiber associated with it. However, inother implementations of the invention, each sensor opening of thesensor probe may have multiple fibers—two or more—associated with it.Alternatively, each opening of the probe may have multiple light pathsor light channels associated with it.

FIG. 5 shows a catheter device 500 with a sensor probe 516 that has afiber optic bundle in each sensor opening. Each fiber optic bundleconsists of two or more optical fibers mechanically bonded together,instead of a single optical fiber. Sensor probe 516 has five sensoropenings 501-505 where each sensor opening has a fiber optic bundle.

In an implementation, the fiber optic bundles in openings 501-504 can beused to transmit light into a tissue, and the fiber optic bundle inopening 505 can be used to receive light reflected from the tissue backto a photodetector. In another implementation, fiber optic bundleopenings 501 and 502 can be used to transmit light into a tissue, andthe fiber optic bundles in openings 503-505 can be used to receive lightreflected back by the tissue. A number of different arrangements ofsensor openings can be used to transmit light to and receive light froma tissue.

FIG. 6A shows an implementation of a catheter device 600 where a sensorprobe 612 has a single optical fiber with multiple light paths. Thisoptical fiber may be referred to as a split channel fiber. There is asingle circular fiber 611 with two semicircular light channels 613 and614.

In a specific implementation, light channel 613 is a source channel andlight channel 614 is a detector channel. For example, light channel 613may be used to transmit light into the tissue and light channel 614 maybe used to receive light from the tissue. In another implementation,light channel 613 is instead the detector channel and light channel 614is the source channel.

FIG. 6B shows another implementation of a catheter device 620 with asingle sensor opening 622 having an optical fiber with multiple lightchannels. There is a concentric core fiber 621 having an inner lightchannel 623, which is surrounded by an outer core light channel 624.

In a specific implementation, the inner core light channel is a sourcechannel and the outer core light channel is a detector channel. However,in another implementation, the inner core light channel is a detectorchannel and the outer core light channel is a source channel.

Although light channels shown in FIGS. 6A and 6B are semicircle andconcentric circles, respectively, these light channels can have anyshape. Some examples of the various shapes that they may have includepolygons (e.g., square, rectangle, triangle, and parallelogram), shapeswith curved line segments (e.g., oval, ellipse, and crescent), orcombinations of these.

In another implementation of the invention, an oximeter sensor at thetip of a retractor includes only a single opening, rather than multipleopenings, and a single optical fiber or single optical fiber bundle isconnected to the single opening. The optical fiber or optical fiberbundle may be made of glass or plastic. In this implementation, a singleoptical fiber or fiber bundle is used to emit light into a tissue and toreceive reflected light from the tissue from the same opening at the tipof the sensor probe.

FIG. 7A illustrates an implementation where a single optical fiberbundle is connected to a single opening at the tip of a sensor probe.Shown in FIG. 7A is a single optical fiber bundle 711 which is connectedto a single opening at the tip of a sensor probe (referred to as “probehead” 713 in FIG. 7A). A cross section of a fiber bundle 711 c showsthat about a half of the optical fibers in the bundle (referred to asoptical fibers 722) is used for emitting light. The other half of theoptical fibers in the bundle (referred to as optical fibers 724) is usedfor returning light.

As shown in FIG. 7A, optical fibers 722 are connected to a laser diode717, and optical fibers 724 are connected to a photodiode 720. Whenlight is emitted from laser diode 717, optical fibers 722 carry thelight into a tissue 727. The light scatters in the tissue and isreflected back to optical fibers 724 which return an attenuated versionof the light to the photodiode. The emitting light and returning lighttravels in the same single fiber bundle, but in opposite direction.

Any suitable number of optical fibers can be contained in a singlebundle. For example, an optical fiber bundle may contain two (a firstfiber for emitting light and a second fiber for returning light), three,four, five, six, tens, hundreds, or more optical fibers. In an opticalfiber bundle, a number of optical fibers used for emitting light may notequal to those used for returning light. For example, if the bundle hasfive optical fibers, two optical fibers may be used for emitting lightand three optical fibers may be used for returning light, or vice versa.

FIG. 7B illustrates another implementation of the invention where adistal end of a single plastic optical fiber 731 (not a bundle) isconnected to an opening at the tip of a sensor probe (referred to as“probe head” 733 in FIG. 7B). At a proximal end of single optical fiber731, the fiber is connected to two separate optical fibers 735 and 737by a 1-to-2 (i.e., Y-shaped) fiber or beam combiner 739. Typically, thefiber combiner contains a black separating bar 741 to reduce cross talkbetween the emitting light and returning light at the two surfacesbetween the three fibers.

In the implementations shown in FIGS. 7A and 7B, the returning light ismainly light back scattered by hemoglobin in the outer, superficialsurface of a tissue and a shallow volume of the tissue underneath theouter surface. This is because a distance between an emitting opticalfiber and returning optical fiber is less than the diameter of theoptical fiber bundle (e.g., 1 millimeter). The light being returned hasnot traveled deeply into the tissue. Therefore, the returning lightcarries more information about oxygen saturation level of the outersurface of a tissue and a shallow volume of the tissue underneath, not awhole block of tissue deep underneath the outer surface. Accordingly,the implementations shown in FIGS. 7A and 7B are particularly useful inmeasuring oxygen saturation of a thin layer of tissue.

In the implementations discussed so far, distal ends of optical fibersin the catheter devices are located at a flat end surface of thecatheter device. However, distal ends of the optical fibers may belocated at any other suitable locations in the catheter device. Forexample, distal ends of the optical fibers may be located at aperipheral surface (i.e., around the circumference) of the catheterdevice at its tip.

FIG. 8A illustrates a catheter device 800 that includes multiple opticalfibers, where distal ends 803 (i.e., sensor openings) of the opticalfibers are located at a peripheral surface of the catheter device at itstip, rather than at a flat end surface of the catheter device. The outersheath of the catheter device has a number of openings, at which distalends of the optical fibers are attached. The distal ends of the opticalfibers are affixed to the openings in the outer sheath using epoxy orother suitable filler material. While nine sensor openings are shown inFIG. 8A, any suitable number of sensor openings may be present at thetip of the catheter device.

FIG. 8B illustrates a variation of a catheter device shown in FIG. 8A.Shown in FIG. 8B is a catheter device 830 that has multiple opticalfibers where distal ends 833 of the optical fibers are located at aperipheral surface of the catheter device at its tip. In thisimplementation, the catheter device also includes an inflatable balloon835 which can be expanded by injecting air or other gas from itsproximal end (now shown). Outer sheath 837 at the tip of the catheterdevice is elastic so that when the balloon expands, the outer sheathingat the tip of the catheter device expands as well.

The catheter devices shown in FIGS. 8A and 8B are particularly useful inmeasuring oxygen saturation level of a tubular organ such as theintestine. The tip of the catheter device can be expanded by a balloonso that multiple sensor openings at the tip of the catheter device cancontact an interior wall of the intestine. Thus, multiple opticalmeasurements can be made simultaneously. By adjusting an amount of fluid(gas or liquid) in the balloon, the tip of the catheter device can beexpanded sufficiently so that distal ends of the optical fibers cancontact a whole section of the intestinal wall.

The catheter devices described above are typically inserted into themouth or anus and is guided down to a body cavity (e.g., intestine) tomake oxygen saturation measurements of a desired area. The catheterdevices can be guided to a desired location in the body by a number ofdifferent ways.

In one implementation, the optical fibers in the sensor probe can servea dual function—measuring tissue oxygen saturation, as well asilluminating and viewing the tissue. As described above, a sensor probetip contacts a tissue and transmits a near infrared light or visiblelight having a wavelength between about 600 nanometers to about 900nanometers to measure oxygen saturation value of the tissue. To view thetissue, the tip of the sensor probe can be kept some distance away fromthe tissue (without contacting the tissue) so that light from the sensorprobe can illuminate the tissue.

To illuminate the tissue using the sensor probe, any suitablewavelengths of light can be used. For example, the signal emitter whichis connected to the sensor probe can generate the same wavelengths oflight for measuring oxygen saturation of a tissue and to illuminate andview the tissue.

Alternatively, the signal emitter can generate different wavelengths oflight, for example a broad band of white light in a visible spectrum, toobtain an image of the tissue. In this implementation, visible light canbe used to guide the sensor probe to a desired location of theintestine. When the sensor probe reaches the desired location, thevisible light can be turned off and the signal emitter can switch tolight in an infrared spectrum to make oxygen saturation measurements.

In another implementation, the catheter devices can be guided inside thepatient's body by using a separate imaging device. For example, thecatheter devices can be viewed inside the patient's body with an aid ofan ultrasound device, X-ray device, CT scan, MRI scan, PET scan orothers. With an assistance of these imaging devices, the tip of thecatheter device can be guided to a desired location in the intestine tomake oxygen saturation measurements.

In yet another implementation, the catheter device or sensor probe(without an outer sheath) can be incorporated into a conventionalendoscopic device. A conventional endoscopic device typically includesan elongated shaft which can be inserted into a body cavity, a lightdelivering element to illuminate an internal tissue, and an imagedetecting element transmitting the image of the tissue back to a viewer.Thus, by combining a sensor probe (or catheter device) of the presentinvention with a conventional endoscopic device, the doctor can view thetissue while measuring oxygen saturation of the tissue using the sensorprobe.

FIG. 9A shows a schematic diagram of a system that includes anendoscopic device 910 into which a sensor probe 913 is incorporated.Endoscopic device 910 has a control head 915 and an elongated shaft 917which are connected together. Control head 915 also connects elements inthe elongated shaft to a light source 921 and an image monitor 923 by acord 925. Sensor probe 913 is connected to a console 931 by a cable 933.

Elongated shaft 917 contains a light delivering element 951 (shown inFIG. 9B) that provides light to illuminate a tissue to be examined. Thelight delivering element typically includes a fiber optic bundle that isconnected to an external light source 921 by a cord 925. The lightbundles run uninterruptedly from the tip of the elongated shaft throughcord 925 directly to light source 921. The image of the tissue is pickedup at an image detecting element 955 (shown in FIG. 9B). The imagedetecting element typically includes a coherent fiber optic bundle whichtransfers the image to an eyepiece 927. Alternatively, the image can betransferred to a camera which sends signals via cord 925 to imagemonitor 923, where the doctor can view the tissue on a monitor screen.

Control head 915 controls functions of several components. For example,the control head can contain a deflection control 919 which allowsremote control of the tip of elongated shaft 917, in order to maneuverit and guide it through body cavities. The tip portion of the elongatedshaft 917 may be bendable by deflection control 919 to get a clearerview of the area to be observed. The control head can also contain acontrol button for gas 945 and a control button for suction 947 whichcan be used to clear damaged tissue and other debris around the tip ofthe elongated shaft.

The control head can also include one or more ports 949 for aninstrument channel which runs along the longitudinal axis of elongatedshaft 917. The instrument channel in an endoscopic device is typicallybetween about 2 millimeters to about 6 millimeters, more typicallybetween about 2 millimeters to about 4 millimeters, in diameter. Theinstrument channel can be used to insert any thin, flexible tools suchas biopsy forceps, needles, and other tools through the elongated shaftand into the field of view during a surgical procedure.

In one implementation of the invention, sensor probe 913 can beincorporated into the instrument channel of an endoscopic device asshown in FIGS. 9A and 9B. The endoscopic device can have an additionalinstrument channel so that another tool, such as a biopsy needle, can beinserted into the channel and a biopsy of a tissue sample can beobtained during an examination.

FIG. 9B illustrates a detail view of a tip of elongated shaft 917 shownin FIG. 9A. Sensor probe 913 can be manipulated at its proximal end nearport 949 (shown in FIG. 9A) by hand or robotically so that it can beextended beyond the distal end surface of the elongated shaft. In sensorprobe 913, there are two optical fibers 961 and 963. One optical fibercan be used to emit light into a tissue, and the other optical fiber canbe used to detect an attenuated version of the light that has reflectedfrom the tissue. The extension of the sensor probe beyond the distal endsurface of the elongated shaft may allow a doctor to clearly view thetissue while taking oxygen saturation measurements of the tissue.

Alternatively, the sensor probe may be affixed at and flushed with thedistal end surface of the elongated shaft of an endoscopic device.Rather than manipulating the sensor probe itself, the tip of theelongated shaft of the endoscopic device can be maneuvered by deflectioncontrol 919 so that the tip of the elongated shaft can be bent andcontact a tissue at a desired location.

While FIGS. 9A and 9B illustrate an embodiment where a sensor probe isincorporated into an instrument channel of an endoscopic device, asensor probe can be located elsewhere. For example, a sensor probe canrun along parallel to the elongated shaft of an endoscopic device. Thesensor probe can be affixed to an outer surface of the elongated shaftby a shrink wrap tubing or by other fastener.

Embodiments shown in FIGS. 9A and 9B have advantages in that a sensorprobe is combined with an endoscopic device that has a built-in lightdelivering element and an image detecting element for viewing a tissue.Thus, the use of an additional imaging device is not necessary to viewthe tissue. Further, an additional instrument channel present in theendoscopic device allows a doctor to take a biopsy of a tissue sample orto treat the tissue when the sensor probe measurements indicate anomalyin the tissue.

In another aspect of the invention, a device includes a markingmechanism near a tip of a sensor probe. The marking mechanism includes afeature that allows a doctor to mark or place a visible trace on atissue. When sensor probe measurements indicate that a particular areaof the intestine or mesentery has an oxygen saturation valuesubstantially lower than a normal range, then it may be desirable tomark the area using the marking mechanism. The markings provide a visualindicator for the doctor for a subsequent treatment or operation.

FIG. 10A illustrates an embodiment of a catheter device 1000 thatincludes an elongated tube 1001, such as a catheter, with two lumens1003 and 1004. A sensor probe 1006 is disposed inside lumen 1004. Amarking mechanism 1007 is disposed in lumen 1003 of the catheter device.A middle portion of the catheter device is omitted in FIG. 10A, and aproximal end of the catheter device is shown on the left hand side ofFIG. 10A. The catheter device in embodiments of the invention allows thedoctor to make oxygen saturation of a tissue at the same time as markingthe tissue as necessary or desired.

In one implementation, marking mechanism 1007 can include an injectionneedle. As shown in FIG. 10A, the marking mechanism has a long cannula1013 with a beveled needle 1009 at its distal end so that the needle canpuncture and tattoo a tissue. The marking apparatus also has a housing1011 which is connected to a proximal end of cannula 1013, and thehousing holds a marking agent. The marking agent stored in the housingcan be released into beveled needle 1009 by pushing onto a plunger 1015.

Any suitable marker that is compatible with a human body can be used inembodiments of the invention. In one embodiment, a marker is abiocompatible dye or ink. For example, a marker can be india ink,methylene blue, boluidine blue, congo red, or others. India ink providesa permanent marking for a bowel tissue. Thus, india ink can be usedduring an exploratory procedure so that marking can be viewed during asubsequent surgery. Alternatively, methylene blue can be used to mark atissue during an operation, as it provides a temporary marking of abowel tissue.

In another embodiment, a marker can be a solid marker. For example, amarker can be magnetic particles which can be tattooed or injected intoa tissue. A tissue marked with magnetic particles can be localized in asubsequent surgery by using a magnetic or ultrasound detector.

In another implementation, a marking mechanism is incorporated into anextra instrument channel of an endoscopic device. FIG. 10B illustrates adistal end of an elongated shaft of an endoscopic device. An elongatedshaft 1051 of an endoscopic device has a light delivering element 1053and an image detecting element 1055. The elongated shaft of theendoscopic device also includes two channels 1057 and 1059 along itslongitudinal axis. Channel 1057 includes a sensor probe 1058 having anoximeter sensor at its tip. Channel 1079 includes a marking mechanism1061.

A marking mechanism can be made of any suitable instruments. Forexample, these include a sclerotherapy needle, an injection syringe, orothers. When the elongated shaft of the endoscopic device travels insidethe intestine, the distal end of the marking mechanism remains inchannel 1059 to avoid accidental puncture of the intestine. When thedoctor desires to mark a tissue, a beveled needle end of the markingmechanism is extended beyond the distal end of the elongated shaft. Thebeveled needle end of the marking mechanism can spray, tattoo, or injecta tissue with a marking agent.

While FIGS. 10A and 10B illustrate the use of a beveled needle to applya marking agent to a tissue, other types of devices can be used as amarking mechanism. For example, rather than having a beveled needle tomark a tissue, the marking mechanism may include a sponge tip, a felttip, or a ball-pen-like output end to apply a dye or ink onto a tissue.

The implementations discussed so far are used by introducing the devicethrough a natural orifice of the body—such as the mouth or anus—tomeasure oxygen saturation of a mucosal surface (i.e., inner surface) ofthe intestine, or other body cavities. To measure oxygen saturation of aserosal surface (i.e., outer surface) of the intestine or mesentery, thecatheter devices and endoscopic devices described above can beintroduced into an abdominal cavity using a trocar or other incisionapparatus. However, incisions in the abdominal tissue can lead tocomplications such as infection, adhesion of tissues underlying theincision, and hernia.

In another aspect, embodiments of the invention provide a device thatcan be introduced into an abdominal cavity with a small pin size hole inan outer tissue (e.g., abdominal skin and underlying connectivetissues). Such device can be used to make oxygen saturation measurementsof a serosal surface of the intestine or mesentery. Since no incision isrequired for this device, the use of the device will result in minimaldiscomfort, and reduced healing time and less medical complications forthe patient.

FIG. 11A shows a needle sensor device 1100 which can be introducedinside the body through the skin, rather than through natural orificesof the body to make oxygen saturation measurements of internal tissues,such as a serosal surface of the intestine or mesentery. The needlesensor device includes a hollow needle 1103 with a beveled edge 1105 atits distal end and a needle hub 1107. The needle sensor device furtherincludes a sensor probe 1111 which is disposed inside hollow needle1103. An oximeter sensor 1113 at a distal end of the sensor probe islocated near beveled edge 1105. A proximal end of the sensor probe has aconnector 1115, which connects the sensor probe to a monitoring console1121 via a cable.

FIG. 11B shows a more detailed view of a distal end of the needle sensordevice shown in FIG. 11A. A distal end of needle sensor device 1100 hashollow needle 1103 with a beveled edge 1105. Oximeter sensor 1113 at adistal end of the sensor probe is located near the beveled edge of thehollow needle. Typically, the device as shown in FIG. 11B (with thesensor probe disposed inside the hollow needle) is used to puncture anouter tissue and to introduce the device inside the body.

FIG. 11C shows another view of a distal end of needle sensor device1100. As shown in FIG. 11C, oximeter sensor 1113 at a distal end of thesensor probe is extended beyond the beveled edge of the needle sensordevice. The sensor probe fits snugly inside the hollow needle, and itcan be manipulated from its proximal end to slide back and forth insidethe hollow needle. Once the hollow needle is introduced inside the body,the sensor probe can be extended beyond the beveled edge of the needlesensor device to make contact with a tissue where oxygen saturationmeasurements are desired.

The hollow needle can be made of any suitable material, such as surgicalgrade stainless steel, titanium, aluminum, plastics, ceramics,composites, or others. The needle hub can be made of the same materialas the hollow needle or of a different material. For example, the needlehub may be made of plastics while the hollow needle is made of stainlesssteel for a needle sensor device.

While the needle sensor device shown in FIG. 11A includes a needle hubwhich makes it convenient for the doctor to hold the device andintroduce the hollow needle into a body, the device does not necessarilyhave to include the needle hub. Rather, the needle sensor device mayonly include a hollow needle and a sensor probe. The shape of a hollowneedle can be derived from any suitable needle, such as a biopsy needle,core biopsy needle, phiebotomy needle, spinal tap needle, Verres needle,or others.

The dimension of a hollow needle used in a needle sensor device can varydepending on its application. It is desired that the hollow needle has asmall diameter of about 5 millimeters or less, more typically about 4millimeters or less, even more typically about 3, 2, 1, 0.5 millimetersor less. The length of the hollow needle can also vary, typically fromabout 5 centimeters to about 40 centimeters, depending on the depth of atissue that the doctor desires to reach inside the body.

In another aspect of the invention, a needle sensor device can be usedin combination with a trocar. A trocar is a hollow cylinder with asharply pointed end that is used to introduce cannulas and other similarimplements into body cavities. The cannula contained in the trocar isinserted through the skin to access a body cavity in which laparoscopicor other type of surgery is to be performed. The trocar often functionsas a portal for the subsequent placement of other instruments forsurgery.

Although the needle sensor device can be used alone to puncture an outertissue (e.g., skin, abdominal wall, and others) and to introduce asensor probe inside the abdomen to measure oxygen saturation of theintestinal or mesentery tissue, a trocar can also be used to puncturethe outer tissue, particularly when the outer tissue is too thick forthe needle sensor device to puncture through. Then a needle sensordevice (or a catheter device in accordance with the present invention)can be introduced into the abdominal space through the trocar.Furthermore, the trocar can be used as a portal to place other surgicalinstruments into the abdomen.

FIG. 11D shows an embodiment where a trocar is used in combination witha needle sensor device. A trocar 1130 has a hollow tube or cannula 1135with a pointed end 1131 which can be used to puncture an abdominal wall1140. A proximal end 1133 of the trocar has an opening to introducevarious instruments. As shown in FIG. 11D, a needle sensor device 1100is introduced through the opening at the proximal end of the trocar. Asensor probe 1113 of the needle sensor device can be manipulated andpushed through the distal end of the trocar. Once the sensor probe isinside the abdominal cavity, it can contact and measure oxygensaturation of the intestinal or mesentery tissue.

The devices according to embodiments of the invention have manyapplications. For example, the devices can be applied in diagnosingintestinal ischemia in a patient by measuring oxygen saturation level ofan intestinal tissue or mesentery. Furthermore, if oxygen saturationmeasurements indicate that an area in the intestine may not be viable,then the area can be marked with a marking mechanism for subsequentresection surgery. The devices can also be used to monitor an intestinaltissue that has gone through a surgical procedure to determine if thesurgery was successful in removing a nonviable tissue and preserving aviable tissue.

In one implementation, the devices in accordance with the presentinvention can be used as a diagnostic tool for detecting intestinalischemia in a patient. Symptoms of intestinal ischemia are broad andvague. There is no single set of symptoms which can fully predict thetype of ischemic injury. Subsequently, intestinal ischemia is difficultto diagnose.

There are some common symptoms for different types of ischemia. The mostcommon form of ischemic injury to the intestine is colon ischemia. Colonischemia usually results in sudden, mild-to-moderate left-sidedabdominal pain with an urgent desire to defecate. Also, the patienttypically passes bright red or maroon colored blood mixed with the stoolwithin 24 hours after the onset of the abdominal pain.

Another type of ischemia is an acute episode of small intestinalischemia which typically begins with the sudden onset of severeabdominal pain. Early in the process, the abdomen is usually soft, flat,and not tender to touch. Also, an abdomen may also be distended. Ifsmall intestinal ischemia is caused by an acute arterial occlusioncaused by an embolus, then the patient may suffer a sudden, forcefulbowel movement associated with severe abdominal pain.

Another type of small intestinal ischemia is caused by an arterial orvein obstruction due to thrombus. This type of intestinal ischemiadevelops more slowly over weeks to months. Typically, it begins withabdominal pain after meals, weight loss, and a change of bowel habits.Other symptoms may include nausea, vomiting, and diarrhea with orwithout blood.

Chronic small intestinal ischemia is typically associated with dull,cramping abdominal pain felt 10 to 30 minutes after eating and reachesits peak 1 to 3 hours after a meal. The pain can increase in severity tothe point where the patient fears eating and exhibits a severe weightloss.

When a patient presents some of the symptoms described above, it isdifficult for the doctor to determine if the symptoms are due tointestinal ischemia or other unrelated conditions. A doctor typicallyconsiders the patient's medical history, symptoms, and physical exam,followed by imaging tests such as ultrasound, X-ray, CT scan, or Millscan to help determine if the symptoms are related to intestinalischemia.

If blockage of mesenteric blood vessels is suspected, the doctor mayorder angiography, a special X-ray study of the blood vessels. Whileangiography may be helpful in determining if blockage in mesentericblood vessels is causing intestinal ischemia, other types of intestinalischemia (e.g., chronic small intestinal ischemia, nonocclusive acutesmall intestinal ischemia, and others) are difficult to diagnose.

Since the devices according embodiments of the invention directly assessthe oxygenation state of the intestine and mesentery, the devicesprovide a better diagnostic tool in determining whether a patient issuffering from intestinal ischemia due to poor oxygenation of theintestinal tissue or mesentery. Thus, the doctors can use embodiments ofthe invention to determine if the patient's symptoms are directlyrelated to an ischemic condition of the intestine or mesentery.

FIG. 12 is a flow diagram that shows a method of measuring oxygensaturation level of the intestine or mesentery using a device inaccordance with the present invention and determining if the patientsuffers from intestinal ischemia.

A specific flow is presented, but it should be understood that theinvention is not limited to the specific flows and steps presented. Aflow of the invention may have additional steps (not necessarilydescribed in this application), different steps which replace some ofthe steps presented, fewer steps or a subset of the steps presented, orsteps in a different order than presented, or any combination of these.Further, the steps in other implementations of the invention may not beexactly the same as the steps presented and may be modified or alteredas appropriate for a particular application or based on the data.

First, in a step 1205, to measure oxygen saturation values of a mucosalsurface of the intestine, a doctor inserts a catheter device orendoscopic device into a gastrointestinal tract of a patient, eitherthrough the mouth or anus. Alternatively, to measure oxygen saturationvalues of a serosal surface of the intestine or mesentery, the doctorpunctures an outer tissue (e.g., skin) with a needle sensor device intoan abdominal cavity. The device can be guided inside the body cavitywith an aid of ultrasound, MRI, or light delivering element of theendoscopic device as described above.

In a step 1210, when the tip of the device reaches a desired location inthe intestine or mesentery, the sensor probe at the tip of the devicecan be manipulated to contact a target tissue. When the sensor probemakes a proper contact with the target tissue, then the computer whichis connected to the sensor probe via optical fibers will indicate thatthe signal quality factor is acceptable or within a normal range.

In a step 1215, once the tip of the sensor probe makes a proper contactwith the target tissue, a computer (e.g., console) directs a signalemitter (connected to the sensor probe and the computer) to transmitlight to the sensor probe, and into the target tissue. After the lightis transmitted into the tissue, some of the light is reflected off ofthe tissue. Typically, the signal emitter transmits light having awavelength between about 600 nanometers to about 900 nanometers. In aspecific implementation, the signal emitter transmits an optical signalhaving two or more different wavelengths to be transmitted through thesensor probe, where a first wavelength is about 690 nanometers, and asecond wavelength is about 830 nanometers.

In a step 1220, a detector (connected to the sensor probe and thecomputer) detects the light reflected off of the target tissue. Thedetector then sends this light information to the computer.

In a step 1225, the computer calculates the oxygen saturation of thetarget tissue using this light information.

In a step 1230, the computer calculates the measured oxygen saturationof the target tissue with a threshold value.

A normal range of oxygen saturation for the intestine or mesentery mayvary between about 60 and 90 percent. Thus, a threshold value fordetermining if a region in the intestine is suffering from ischemia maybe set at 60 percent or below. For example, the threshold value may beset at 59, 55, 50, 45, 40, 35, 30, 25, 20, 15, 10, 5, 0 percent, or anyother numbers in this range. The threshold value can vary depending onwhich region of the intestine was tested for oxygen saturation level.Accordingly, depending on the intestinal region being tested or otherfactors, the threshold value may be set at a different level.

The steps shown in FIG. 12 can be repeated after moving the sensor probeto different locations in the intestine or mesentery.

In a step 1235, if the patient presents various symptoms described aboveand if the oxygen saturation measurements from one or more regions ofthe patient's intestine or mesentery are lower than a threshold value,then a patient can be diagnosed as having intestinal ischemia. Sinceembodiments of the invention directly assess the oxygenation state ofthe intestine and mesentery, the doctor can make a more definitivediagnosis of intestinal ischemia in a patient.

The flow diagram shown in FIG. 12 can also be applied in monitoringoxygen saturation level of the intestine or mesentery during a surgicalprocedure. If symptoms of intestinal ischemia are severe in a patientand the doctor suspects that a portion of the intestine is infracted(dead), the doctor may decide to perform a resection of a dead tissuefollowed by an anastomosis. In determining which intestinal tissue maybe viable or nonviable, the doctor can use the devices of the presentinvention, rather than relying on subjective criteria such as color ofthe intestine.

In determining which intestinal tissue is viable or nonviable during asurgery, the doctor can follow steps 1210 through 1230 in the flowdiagram provided in FIG. 12. As stated above, the threshold value forviability of a tissue may differ depending on tissue type, age of thepatient, or the patients' medical history. For example, a thresholdvalue for viability of the colon may be selected at 40 percent oxygensaturation level, where a threshold value for viability of the smallintestine may be selected at 35 percent oxygen saturation level.

Furthermore, the flow diagram shown in FIG. 12 can be used to monitoroxygen saturation level of the intestine or mesentery after surgery orother treatment. Even after an anastomosis procedure, there is a riskthat rejoined portions of the intestine may fail if there is too muchstrain or limited vascular supply to the rejoined portions. Since thedevices of the present invention can monitor the oxygenation state ofthe intestine noninvasively, they can be applied to determine if thejoined portions of the intestine are adequately oxygenated and healthy.

In another aspect of the invention, the method in accordance with thepresent invention includes marking a portion in the intestine ormesentery after a sensor probe makes oxygen saturation measurements.Prior to a surgical procedure, the doctor may desire to notate a portionof the intestine that is viable or nonviable based on oxygen saturationmeasurements of the tissue. The devices with a marking mechanism inaccordance with the present invention can be used to mark either viableor nonviable portions of the intestine prior to a resection procedure.By clearly marking the tissue prior to or during the surgery, the doctorcan clearly view which portion of the intestine needs to be resected ortreated.

FIG. 13 is a flow diagram that shows a method of measuring oxygensaturation level of a tissue in the intestine or mesentery using adevice with a marking mechanism in accordance with the presentinvention. The steps in FIG. 13 can be followed to mark a portion of theintestine or mesentery that has a poor oxygen saturation level, whichmay be indicative of infarction of the tissue. Most of the steps shownin FIG. 13 are similar to those shown in FIG. 12.

First, in a step 1305, to measure oxygen saturation values of mucosalsurface of the intestine, a doctor inserts a catheter device orendoscopic device into a gastrointestinal tract of a patient, eitherthrough the mouth or anus. Alternatively, to measure oxygen saturationvalues of a serosal surface of the intestine or mesentery, the doctorpunctures an outer tissue (e.g., skin) with a needle sensor device intoan abdominal cavity. Typically, the device is guided inside the bodycavity with an aid of ultrasound, MRI, or image detecting element of theendoscopic device as described above.

In a step 1310, when the tip of the device reaches a desired location inthe intestine or mesentery, the sensor probe at the tip of the devicecan be manipulated to contact a target tissue.

In a step 1315, once the tip of the sensor probe makes a proper contactwith the target tissue, a computer (e.g., console) directs a signalemitter (connected to the sensor probe and the computer) to transmitlight to the sensor probe, and into the target tissue. After the lightis transmitted into the tissue, some of the light is reflected off ofthe tissue.

In a step 1320, a detector (connected to the sensor probe and thecomputer) detects the light reflected off of the target tissue. Thedetector then sends this light information to the computer.

In a step 1325, the computer calculates the oxygen saturation of thetarget tissue using this light information.

In a step 1330, the computer calculates the measured oxygen saturationof the target tissue and compares it with a threshold value. Thethreshold value may vary depending on many factors. As noted above, anormal range of oxygen saturation level may vary depending on theintestinal region from which oxygen saturation measurements are made.However, if the oxygen saturation value of an intestinal tissue issubstantially lower than the normal range, then it may be consideredthat the tissue is not viable. For example, the threshold value ofnonviability of a tissue may be set at 59, 55, 50, 45, 40, 35, 30, 25,20, 15, 10, 5, 0 percent, or any other number in the range by thedoctor.

Once it is determined that the measured oxygen saturation value of thetarget tissue is lower than the threshold value, then the target tissueis marked with a marking mechanism. As described above, the tissue canbe marked with an ink or dye (e.g., india ink) or solid particles (e.g.,magnetic particles). The markings on the tissue provide a clear visualindicator for the doctor when the patient goes through a subsequentsurgery or treatment.

In another aspect of the invention, the effects of a temporary inducedischemia on intestinal or mesentery tissue oxygen saturation can beanalyzed to determine if a patient is suffering from intestinalischemia. A temporary ischemic period can be induced on an intestinal ormesentery tissue by using a device that constricts a mesenteric artery.Since the tissue continues to consume remaining oxygen from blood (withno or little influx of fresh arterial blood), tissue oxygen saturationwill decline gradually during the temporary ischemic period. If thetissue is healthy and normal, then stopping or reducing the blood flowto the tissue will result in a significant reduction of measured oxygensaturation over time. If the intestinal or mesentery tissue alreadysuffers from ischemia (e.g., due to clogged mesenteric arteries orinfarct intestinal tissue), then stopping or reducing the arterial bloodflow will not significantly reduce measured oxygen saturation of thetissue.

FIGS. 14A through 14E illustrate methods for determining which portionof the large intestine suffers from intestinal ischemia by inducing atemporary ischemia. The figures also illustrate how oxygen saturationmeasurements during the temporary induced ischemic period can be usedduring resection and anastomosis procedures.

FIG. 14A shows five different mesenteric arteries labeled A, B, C, D,and E which supply blood to different portions of the large intestinelabeled 1, 2, 3, 4, 5, and 6. One artery can supply more than oneselected portion of the large intestine. As shown, a blood supply to thelarge intestine can be reduced or stopped by clipping one or moremesenteric arteries at a time or simultaneously. Clipping the mesentericarteries can be achieved during an open abdominal surgery.Alternatively, a trocar can be used to introduce a device to constrictmesenteric arteries (e.g., clip). Other methods, such as pressing downon arteries, can be used to reduce or stop blood supply to theintestinal or mesentery tissue to induce a temporary ischemia. Anysuitable oximeter devices (e.g., a catheter device, an endoscopicdevice, or a needle sensor device) can be used to measure oxygensaturation of the intestinal or mesentery tissue during the temporaryinduced ischemic period.

FIG. 14B shows oxygen saturation measurements from intestinal portions1, 2, or 3 of the large intestine. Initially (at time 0), the tissueoxygen saturation level at portions 1, 2, or 3 is high. Once themesenteric arteries A or B are clipped (which supply blood to portions1, 2, and 3), the oxygen saturation levels of these portions decreaseover a time period. This result indicates that intestinal portions 1, 2,and 3 are healthy and normal, and that they normally receive adequateblood supply from mesenteric arteries A and B.

FIG. 14C shows oxygen saturation measurements from intestinal portions4, 5, and 6. The initial value of tissue oxygen saturation level atthese portions is low, when compared to the initial value for healthyintestinal portions 1, 2, and 3 shown in FIG. 14B. After clippingmesenteric arties C, D, or E (which supply blood to portions 4, 5, and6), there is a minimal or no decrease of tissue oxygen saturation over atime period of induced ischemia. This result indicates that tissueportions 4 through 6 are already unhealthy or dead. Alternatively,mesenteric arteries C, D, and E are not adequately supplying blood tothese portions because the arteries are clogged, inflamed, or diseased.

Once it is determined that tissue portions 4, 5, and 6 are not viable, aresection of these portions of the large intestine can be performed asshown in FIG. 14D. Once the nonviable portion of the large intestine isresected, an anastomosis procedure can be performed by ligating ahealthy end portion 3 with the anus region of the patient as shown inFIG. 14E. Once a nonviable portion of the large intestine is removed,the healthy portions of the large intestine can resume a normal functionof the intestine after healing.

FIG. 15 shows a flow diagram for diagnosing intestinal ischemia in apatient by analyzing changes in oxygen saturation of an intestinal ormesentery tissue in a patient during a temporary induced ischemicperiod.

In a step 1505, oxygen saturation of an intestinal or mesentery tissuein a patient is measured with an oximeter sensor. Any suitable oximetersensor can be used in this step to measure tissue oxygen saturation.

In a step 1510, an ischemia is induced in the intestinal or mesenterytissue by reducing or stopping the blood flow (e.g., by clipping orpressing down the mesenteric artery) to the tissue.

In a step 1515, oxygen saturation of the same portion of the tissue isremeasured with the oximeter sensor after specific time points afterischemia is induced.

In a step 1520, the changes in tissue oxygen saturation during theinduced ischemic period are analyzed.

In a step 1525, the patient can be diagnosed as suffering fromintestinal ischemia if changes in tissue oxygen saturation do not meet athreshold value.

In one embodiment, the analysis in step 1520 may include calculating arate of change of oxygen saturation over a period of time. For example,a mesenteric artery supplying blood to the tissue can be clipped, andoxygen saturation of the tissue can be measured every 10 seconds, 30seconds, one minute, two minutes, or other suitable time intervals. Theblood supply to the tissue can be clipped for any suitable time period,as long as it does not negatively impact the patient's long-term health.For example, the blood supply can be clipped for a period anywherebetween 1 minute, 2 minutes, 5 minutes, 10 minutes, 20 minutes, 30minutes, or any other suitable time period. The measured oxygensaturation (e.g., in terms of percent) can be plotted against time. Therate of change can be calculated using any suitable method. For example,the rate of change can be measured and calculated around a midpoint ofthe induced ischemic period.

The rate of oxygen saturation change can be calculated, and compared toa threshold to determine whether the patient is suffering fromintestinal or mesentery ischemia. A threshold can be set differentlydepending on various factors (e.g., the patient's age, health history,gender, and others). A threshold can be set at any suitable rate, e.g.,at about 3, 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 percent perminute. For example, if the threshold is set at a rate of 20 percentoxygen saturation change per minute and if the patient's rate of changeis calculated to be about 5 percent oxygen saturation change per minute,then the patient is diagnosed as having intestinal ischemia.

In another embodiment, the analysis in step 1520 may include determiningeither an absolute change or relative change in oxygen saturation levelof the intestinal or mesentery tissue. Any suitable time point can beselected for measuring oxygen saturation level. For example, oxygensaturation can be measured before clipping the blood supply. After theblood supply to the intestinal or mesentery tissue is clipped, oxygensaturation can be measured at a selected time point (e.g., 5 minutes, 10minutes, 20 minutes, 30 minutes, and others). Then the change in oxygensaturation level of the tissue can be recorded.

For example, at time zero (before clipping the mesenteric artery), theoxygen saturation value of a tissue is measured at 80 percent. At 10minute time point after the mesenteric artery is clipped, the oxygensaturation of the same tissue is measured at 20 percent. Then theabsolute change of oxygen saturation value may be recorded as being 60percent. Alternatively, the relative change of oxygen saturation valuemay be recorded as being 75 percent (i.e., (80−20)/80). A healthyintestinal or mesentery tissue will have a higher absolute or relativechange in oxygen saturation value (e.g., above 40 percent), whereas anintestinal or mesentery tissue that already suffers from ischemia willhave a lower absolute or relative change in oxygen saturation value(e.g., below 40 percent).

The change in oxygen saturation level at a specific time point can becompared to a threshold. For example, ten minutes into the inducedischemic period can be selected as a time point to calculate theabsolute change in oxygen saturation level of the intestinal ormesentery tissue, and a threshold may be selected at 40 percent. If apatient's oxygen saturation level changed less than 40 percent at tenminute time point during the induced ischemic period, then the patientcan be diagnosed as suffering from intestinal ischemia. If the patient'soxygen saturation level changed more than 40 percent at ten minute timepoint during the induced ischemic period, then the patient can bediagnosed as being normal and healthy.

In addition to using the flowchart shown in FIG. 15 as a diagnostic toolfor intestinal ischemia, the steps shown in FIG. 15 can be repeated andapplied to determine which portion of the intestine or mesentery iscausing intestinal ischemia. As shown in FIG. 14A through 14E, differentmesenteric arteries can be pressed down or clipped, and differentportions of the intestine or mesentery can be tested for their oxygensaturation level. The results of oxygen saturation change at differentportions of the intestine can be used for resection or anastomosisprocedures.

In another aspect of the invention, a recovery pattern from a temporaryinduced ischemia of an intestinal or mesentery tissue can be analyzed todetermine if a patient is suffering from intestinal ischemia. FIGS. 16Aand 16B illustrate patterns of recovery from an induced ischemia for anintestinal or mesentery tissue. In other words, a recovery period showshow oxygen saturation of the tissue increases after a blood flow to themesenteric artery is restored by either removing a clip or releasing thepressure applied to the mesenteric artery. FIG. 16A shows a recoverypattern for a healthy tissue where the tissue oxygen saturation isrestored to the initial value at a relatively fast rate. By contrast,FIG. 16B shows a recovery pattern for a tissue which already suffersfrom intestinal ischemia. In FIG. 16B, the tissue oxygen saturation isrestored to the initial value at a relatively slow rate.

FIG. 17 shows a flow diagram for diagnosing an intestinal ischemia in apatient by analyzing changes in oxygen saturation of an intestinal ormesentery tissue in a patient during recovery after a temporarilyinduced ischemic period.

In a step 1705, an ischemia is induced in the intestinal or mesenterytissue by reducing or stopping the blood flow (e.g., by clipping orpressing down the mesenteric artery) to the tissue.

In a step 1710, oxygen saturation of an intestinal or mesentery tissuein a patient is measured with an oximeter sensor.

In a step 1715, the blood flow to the tissue is restored (e.g., byremoving pressure or clip on the mesenteric artery).

In a step 1720, oxygen saturation of the same portion of the tissue isremeasured with an oximeter sensor during recovery after the blood flowto the tissue is restored.

In a step 1725, the changes in tissue oxygen saturation during recoveryare analyzed.

In a step 1730, the patient can be diagnosed as suffering fromintestinal ischemia if changes in tissue oxygen saturation duringrecovery do not meet a threshold.

In one embodiment, the analysis in step 1725 may include calculating arate of change of oxygen saturation over a period of time duringrecovery. For example, after the blood supply to the tissue is restored(e.g., by removing a clip), oxygen saturation of the tissue can bemeasured every 10 seconds, 30 seconds, one minute, two minutes, or othersuitable time intervals. The measured oxygen saturation (e.g., in termsof percent) can be plotted against time. The rate of change can becalculated using any suitable method. For example, the rate of changecan be measured and calculated around a midpoint of recovery phase(e.g., see FIG. 16A).

The rate of oxygen saturation change can be calculated, and compared toa threshold to determine whether the patient is suffering fromintestinal or mesentery ischemia. A threshold can be set differentlydepending on various factors as noted above. A threshold can be set atany suitable rate, e.g., at about 3, 5, 10, 20, 30, 40, 50, 60, 70, 80,90, 100, or 200 percent oxygen saturation per minute. For example, ifthe threshold is set at a rate of 50 percent oxygen saturation changeper minute and if the patient's rate of change is calculated to be about100 percent oxygen saturation change per minute, then the patient isdiagnosed as not suffering from intestinal ischemia.

In another embodiment, the analysis in step 1725 may include determiningan amount of time required for 80 percent recovery of oxygen saturationfor the tissue after restoring the blood supply to the tissue. For ahealthy, normal tissue, it typically takes less time to achieve 80percent recovery of oxygen saturation for the tissue. By contrast, for atissue which is suffering from intestinal ischemia, it typically takeslonger time to achieve 80 percent recovery of oxygen saturation for thetissue.

The processes shown in FIGS. 12, 13, 15 and 17 are useful in diagnosingintestinal ischemia in a patient, as well as in monitoring and marking atissue with a poor oxygen saturation level in the intestine ormesentery. Since embodiments of the invention can directly assess theoxygenation state of a full thickness of the intestine, they provide abetter diagnostic tool in determining an ischemic condition of theintestine or mesentery at an earlier stage. Early diagnosis ofintestinal ischemia is a key to successfully treating the disease.Embodiments of the invention contribute, among other things, in solvingthe problems related to a diagnosis of intestinal ischemia, locatingischemic tissue portions, as well as improving oxygen saturationmeasurements of the intestinal or mesentery tissue.

This description of the invention has been presented for the purposes ofillustration and description. It is not intended to be exhaustive or tolimit the invention to the precise form described, and manymodifications and variations are possible in light of the teachingabove. The embodiments were chosen and described in order to bestexplain the principles of the invention and its practical applications.This description will enable others skilled in the art to best utilizeand practice the invention in various embodiments and with variousmodifications as are suited to a particular use. The scope of theinvention is defined by the following claims.

The invention claimed is:
 1. A method comprising: through an openingcreated in an outer tissue of an abdominal cavity of a patient,inducing, via a clip, a temporary ischemic period for serosal tissue ofan intestinal or mesentery tissue, which is located in the abdominalcavity of the patient, by using the clip to constrict a mesentericartery that supplies blood to the serosal tissue of the intestinal ormesentery tissue; through the opening, contacting a sensor probe of anoximetry device to a serosal surface of the serosal tissue of theintestinal or mesentery tissue; determining, by the oximetry device, asignal quality factor for contact of the sensor probe of the oximetrydevice to the serosal surface of the serosal tissue of the intestinal ormesentery tissue; measuring, via the oximetry device, whether the signalquality factor for contact of the sensor probe of the oximetry device tothe serosal surface of the serosal tissue of the intestinal or mesenterytissue is within a range that indicates at least threshold contact; whenthe signal quality factor is within the range that indicates at leastthreshold contact, measuring oxygen saturation of the serosal tissue ofthe intestinal or mesentery tissue, via the oximetry device during thetemporary ischemic period, from contacting of the serosal surface of theserosal tissue of the intestinal or mesentery tissue with the sensorprobe; using a processor, analyzing, via the oximetry device, the oxygensaturation of the serosal tissue of the intestinal or mesentery tissueduring a recovery period after the temporary ischemic period; anddiagnosing, via the oximetry device, the patient as having intestinalischemia according to changes in the oxygen saturation in the serosaltissue of the intestinal or mesentery tissue during the recovery periodafter the temporary ischemic period.
 2. The method of claim 1 whereinmeasuring oxygen saturation of the tissue during the temporary ischemicperiod comprises: directing light from one or more optical fibers of atrocar into the serosal tissue, wherein the trocar comprises: a hollowneedle; and the sensor probe comprising the one or more optical fibers,wherein distal ends of the one or more optical fibers are located at atip of the sensor probe forming an oximeter sensor, and the sensor probeis disposed inside the hollow needle; and collecting light by the one ormore optical fibers from the serosal tissue, wherein analyzing theoxygen saturation of the serosal tissue during the temporary ischemicperiod comprises: determining intensity changes of collected light thatis collected by the one or more optical fibers from the serosal tissuefor the temporary ischemic period for measuring the oxygen saturation.3. The method of claim 1 comprising: introducing into the abdominalcavity, through a trocar that is punctured through the outer tissue, aneedle sensor device comprising a hollow needle and the sensor probe,the sensor probe comprising a first optical fiber wherein a distal endof the first optical fiber is located at a tip of the sensor probeforming an oximeter sensor of the oximetry device; transmitting a firstlight, having a wavelength between about 600 nanometers to about 900nanometers into the serosal surface of the serosal tissue of theintestinal or mesentery tissue through the first optical fiber at thetip of the sensor probe; receiving a second light reflected from thetissue through the first optical fiber at the tip of the sensor probe;and determining an oxygen saturation value, via the oximetry device, forthe tissue based on values for the first and second light.
 4. The methodof claim 2 wherein the serosal tissue comprises intestinal tissue. 5.The method of claim 2 wherein the serosal tissue comprises mesenterytissue.
 6. A method comprising: through an opening created in an outertissue of an abdominal cavity of a patient, inducing, via a clip, atemporary ischemic period for serosal tissue of an intestinal ormesentery tissue, which is located in the abdominal cavity of thepatient, by using the clip on a mesenteric artery that supplies blood tothe serosal tissue of the intestinal or mesentery tissue; introducinginto the abdominal cavity, through a trocar that is punctured throughthe outer tissue, a needle sensor device comprising a hollow needle anda sensor probe, the sensor probe comprising a first optical fiberwherein a distal end of the first optical fiber is located at a tip ofthe sensor probe forming an oximeter sensor of an oximetry device;through the opening, contacting the sensor probe to a serosal surface ofthe serosal tissue of the intestinal or mesentery tissue comprising:contacting the serosal surface of the serosal tissue of the intestinalor mesentery tissue with the first optical fiber of the sensor probe,determining the oxygen saturation value, via the oximetry device, forthe serosal tissue comprising: during the temporary ischemic period,transmitting a first light from a second optical fiber of the sensorprobe to the first optical fiber; during the temporary ischemic period,transmitting the first light into the serosal surface of the serosaltissue of the intestinal or mesentery tissue through the first opticalfiber at the tip of the sensor probe; and during the temporary ischemicperiod, collecting reflected radiation from the contacted serosalsurface of the serosal tissue of the intestinal or mesentery tissue viathe first optical fiber of the sensor probe; determining, by theoximetry device, a signal quality factor for contact of the sensor probeof the oximetry device to the serosal surface of the serosal tissue ofthe intestinal or mesentery tissue; measuring, via the oximetry device,whether the signal quality factor for contact of the sensor probe of theoximetry device to the serosal surface of the serosal tissue of theintestinal or mesentery tissue is within a range that indicates at leastthreshold contact; when the signal quality factor is within the rangethat indicates at least threshold contact, measuring oxygen saturationof the serosal tissue of the intestinal or mesentery tissue, via theoximetry device during the temporary ischemic period, from contacting ofthe serosal surface of the serosal tissue of the intestinal or mesenterytissue with the sensor probe; using a processor, analyzing, the oxygensaturation of the serosal tissue of the intestinal or mesentery tissueduring the temporary ischemic period comprising: transmitting the firstlight, having a wavelength between about 600 nanometers to about 900nanometers into the serosal surface of the serosal tissue of theintestinal or mesentery tissue through the first optical fiber at thetip of the sensor probe; receiving a second light reflected from theserosal tissue through the first optical fiber at the tip of the sensorprobe, wherein the receiving the second light reflected from the serosaltissue through the first optical fiber at the tip of the sensor probecomprises, during the temporary ischemic period, transmitting thereflected radiation from the first optical fiber of the sensor probe toa third optical fiber of the sensor probe; and determining an oxygensaturation value, via the oximetry device, for the serosal tissue basedon values for the first and second light; analyzing, via the oximetrydevice, the oxygen saturation of the serosal tissue of the intestinal ormesentery tissue during a recovery period after the temporary ischemicperiod based on the radiation received in the third optical fiber; anddiagnosing the patient as having intestinal ischemia according tochanges in the oxygen saturation in the serosal tissue of the intestinalor mesentery tissue during the recovery period after the temporaryischemic period.
 7. The method of claim 6 wherein a separating bar ispositioned between the second and third optical fibers in a hole whichis formed in a proximal end of the first optical fiber.
 8. A system fordiagnosing an intestinal ischemia, comprising: a device to induce atemporary ischemic period, through an opening in an abdominal wall of apatient to access an abdominal cavity of the patient, in serosal tissueof an intestinal or mesentery tissue, which is in the abdominal cavity,by using a clip device that constricts a mesenteric artery that suppliesblood to the serosal tissue of the intestinal or mesentery tissue; asensor probe comprising a first optical fiber, a second optical fiber,and a third optical fiber, wherein the first optical fiber is adapted todeliver radiation to the second optical fiber, the second optical fiberis adapted to contact the serosal tissue of the intestinal or mesenterytissue during the temporary ischemic period of the serosal tissue foremitting the radiation into the contacted serosal tissue and to detectreflected radiation from the contacted serosal tissue, the third opticalfiber is adapted to receive the reflected radiation from the secondoptical fiber, and based on the reflected radiation received in thethird optical fiber from the second optical fiber, measure oxygensaturation, via the clip device, of the serosal tissue of the intestinalor mesentery tissue during the temporary ischemic period of the serosaltissue; and a system unit, coupled to the sensor probe, which analyzesthe oxygen saturation in the serosal tissue of the intestinal ormesentery tissue during a recovery period after the temporary ischemicperiod and diagnoses, via the device, the patient as having intestinalischemia according to the oxygen saturation in the intestinal ormesentery tissue during the recovery period after the temporary ischemicperiod.
 9. The system of claim 8 wherein the system unit comprises aprocessor.
 10. The system of claim 8 wherein the system unit comprises asignal emitter.
 11. The system of claim 8 wherein the system unitcomprises a signal detector.
 12. The system of claim 8 wherein thesystem unit comprises a signal emitter, coupled to the first opticalfiber, and a signal detector, coupled to the third optical fiber. 13.The system of claim 8 wherein the sensor probe comprises a firstconnector portion and the system unit comprises a second connectorportion, and the first and second connector portions mate with eachother to removably couple the sensor probe and the system unit together.14. The system of claim 8 wherein the sensor probe comprises haptictechnology.
 15. The system of claim 8 wherein the system unit comprisesa rechargeable battery and a recharging circuit comprising an AC-to-DCpower converter.
 16. The system of claim 8 wherein the sensor probecomprises graduated markings on its exterior.
 17. A method comprising:through an opening in an abdominal wall of a patient to access serosaltissue of an intestinal or mesentery tissue that is located in anabdominal cavity of the patient, inducing, via a clip, a temporaryischemic period of the serosal tissue of intestinal or mesentery tissueof the patient by using the clip to constrict a mesenteric artery thatsupplies blood to the serosal tissue of the intestinal or mesenterytissue; through an opening in the abdominal wall, removing, via theclip, a constriction of the mesenteric artery that supplies blood to theserosal tissue of the intestinal or mesentery tissue to induce arecovery from the temporary ischemic period; through an opening in anabdominal wall, contacting, via an oximetry device, a serosal surface ofthe serosal tissue with a sensor probe of the oximetry device;measuring, via the oximetry device, oxygen saturation of the serosaltissue of the intestinal or mesentery tissue during the recovery fromthe temporary ischemic period, after removing the constriction to themesenteric artery; analyzing, via the oximetry device, the oxygensaturation of the serosal tissue of the intestinal or mesentery tissueduring recovery from the temporary ischemic period; and diagnosing, viathe oximetry device, the patient as having intestinal ischemia accordingto changes in the oxygen saturation in the serosal tissue of theintestinal or mesentery tissue during the recovery from the temporaryischemic period.
 18. The method of claim 17 wherein the temporaryischemic period is induced by clipping or adding pressure on themesenteric artery.
 19. The method of claim 17 comprising: puncturing theabdominal wall with a needle sensor device comprising a hollow needleand the sensor probe, wherein a distal end of the first optical fiber islocated at a tip of the sensor probe forming an oximeter sensor.
 20. Themethod of claim 17 wherein the sensor probe comprises a first opticalfiber.
 21. The method of claim 20 comprising: transmitting radiationfrom a second optical fiber of the sensor probe to the first opticalfiber; and emitting the radiation from the first optical fiber into theserosal surface of the serosal tissue.
 22. The method of claim 20comprising: collecting reflected radiation from the serosal surface ofthe serosal tissue via the first optical fiber; and transmitting thereflected radiation from the first optical fiber to a third opticalfiber of the sensor probe, wherein the measuring oxygen saturation ofthe serosal tissue is based on the reflected radiation received in thethird optical fiber.